Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Abstract

Introduction and objectiveUterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients.Material and methodsUterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test.ResultsBefore UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006).ConclusionsThe percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.

Evaluation of uterine artery embolization on myoma shrinkage: Results from a large cohort analysis

“…[19] Available literature data show that 3 months after UAE the median percentage reduction of the dominant myoma volume ranged from only 3 up to even 93%, but on an average, it was around 50%. [3536] After 6-month follow-up, a 40%–60% fibroid volume reduction was observed in most studies. In some prospective studies, 3 years after UAE total uterine volume was reduced significantly, on an average up to 65%.…”

“…[2634] Effects of UAE seem not only to be permanent but also progresses with time. [35] The reported success rate of UAE assessed as the decrease in the largest myoma volume ranges from only 23 to even >90%. [19] Available literature data show that 3 months after UAE the median percentage reduction of the dominant myoma volume ranged from only 3 up to even 93%, but on an average, it was around 50%.…”

Value of Dyna CT in guiding embolization during transarterial uterine artery embolization of fibroids

“…The success of transarterial UAE of fibroids depends on precisely identifying the origin of uterine arteries, along with highly selective catheterization ( 20 ). Previous studies have indicated that excessive embolization may damage normal myometrium, ovaries or fallopian tubes, resulting in uterine necrosis, infections or ovarian failure in rare cases.…”

Uterine artery embolization in the treatment of symptomatic fibroids – state of the art 2018

“…During UAE, performed by an interventional radiologist, embolic material is administered to occlude both uterine arteries, which is achieved by introducing a catheter through the femoral artery into the uterine arteries under X-ray supervision. As a result, blood flow is significantly reduced and ischaemia occurs in the tumour, causing necrosis of fibroid cells [4]. The most important benefits of UAE are uterus preservation and surgery avoidance.…”